Implementation of Parental Stature Assessment in Girls with Turner Syndrome

Research Article

J Pediatri Endocrinol. 2016; 1(2): 1009.

Implementation of Parental Stature Assessment in Girls with Turner Syndrome

Majcher A¹*, Paluchowska M¹, Pyrzak B¹, Witkowska-Sedek E¹ and Kolodziejczyk H²

¹Department of Pediatric and Endocrinology, Medical University of Warsaw, Poland

²Department of Anthropology, The Children’s Memorial Health Institute, Poland

*Corresponding author: Anna Majcher, Department of Pediatric and Endocrinology, Medical University of Warsaw, Poland

Received: September 09, 2016; Accepted: October 19, 2016; Published: October 20, 2016

Abstract

It is common practice among paediatricians to compare the child’s stature at a growth age with that of both parents.

Aim: the assessment of correlation between parental stature and that of girls with Turner Syndrome (TS).

Materials and Methods: A cohort including 186 girls with TS and their parents was evaluated since 1988. The patients, aged 4 months to 17 years, were not receiving GH therapy. The TS girls’ heights and those of their parents were measured by an anthropologist. Arithmetic means and standard deviations were calculated for the entire group of subjects and their parents on the basis of anthropometric data. Mid-parental height (in cm and in SDS) was also determined in each case. For girls at the same calendar age, we have used the arithmetic means and standard deviations given in the current population standards. Parental heights were standardized by calculating the means. Standard deviations were determined by those for a population of the 18-yearolds. The correlation of mid-parental height with short stature of the daughters and their age was assessed. The difference between the mid-parental height (in SDS) and that of the daughter was calculated for each patient separately, assuming that the result should range from 0 to ±1 SDS.

Results: The mean calendar age of girls with TS was 9.46±3.90 years. In 155 girls (83.3%) the height was <-2 SDS, while in 109 patients it was <-3 SDS. The mid-parental height was higher in girls with lower height deficiency (172.1 cm in parents of 37 girls with a height of >-2 SDS versus 164.5 cm of parental height of 20 girls with a height of <-4 SDS). 73.7% of girls markedly differed in height from their parents (>+2 in SDS). Only the height of 9 girls (4.8%) was in the range of ±1 SDS in relation to parental height.

Conclusion: 1. The height of parents of girls with TS has features of a normal distribution in the population.

2. A considerable difference (in SDS) between the mid-parental heights and those of their daughters, found in the study, implies the necessity of including the criterion in the diagnosis of TS.

3. The girls should not be declined genetic diagnostics due to low midparental height.

Keywords: Girls; Turner syndrome; Parental stature

Introduction

It is common practice among paediatricians to compare the child’s height at a growth age with the stature of both parents [1-6]. When both parents and at least one parent alone is of short stature the physician may be inclined to abandon diagnostic procedures and suggest a family history of short stature. Girls with TS constitute approximately 10% of all female patients with short stature seen by endocrinologists in our Department. In some girls the diagnosis is delayed and they experience difficulties in receiving appropriate health care. In the 80-ties and 90-ties of the 20th century, the diagnosis was often established at the age of 15 or later, with no apparent clinical features of puberty. In the 21st century a basic investigation which can make a diagnosis of short stature in girls (even without apparent signs of TS) considerably more straight forward is a karyotype analysis. In the present study, we measured and assessed the stature of the parents of TS girls presenting at 2 centres of paediatric endocrinology in Warsaw in 28 years. The correlation between the parental stature and that of TS girls was also analyzed.

Aim

The aim of the study was to assess the correlation between midparental stature and that of TS girls.

Materials and Methods

186 girls with TS aged 0.25 to 17.42 (mean age was 9.46±3.90) and their parents participated in the study conducted in Anthropology Laboratory in The Children’s Memorial Health Institute and Department of Pediatric and Endocrinology Medical University of Warsaw from 1988 to 2015. The TS diagnosis was confirmed by a cytogenetic test in each case. The patients were to be put on recombinant human Growth Hormone (rhGH) therapy and were not receiving any other hormonal growth promoting treatment. The majority of patients had a karyotype 45X. Due to prolonged collection of data and lack of access to various karyotypes, differentiation in accordance with mosaic karyotypes was omitted in prospective studies. The height measurements of the girls with TS and their parents were performed by anthropologists on a Harpenden Stadiometer in the morning hours. The patient, wearing only underwear, was put in anthropometric position, while the parents in question were wearing light clothing. The measurements of girls’ heights were taken 3 times, with the arithmetic mean calculated, whereas those of the parents only once. On the basis of the anthropometric data, arithmetic mean and standard deviations for the entire cohort of girls, mothers and fathers were calculated, together with the mid-parent height (in cm). For girls at the same calendar age, we have used the arithmetic means and standard deviations given in the current population standards (IMIDZ from 1983, IMIDZ from 2001) [7,8] according to an equation: the mean height for the calendar year-the height of the child in SDS (height Standard Deviation Score). Parental heights were standardized by calculating the means. Standard deviations were determined by those for a population of the 18-year-olds according to the appropriate standards. The height calculated in SDS for each parent separately allowed to obtain the mid-parental height in SDS. The midparental-girl difference in height was then calculated in SDS assuming that the result should range from 0 to ±1 SDS.

Results

In the cohort of 186 girls with TS the mean calendar age of the patients was 9.46±3.90 years. In 155 girls (83.3%) the height was <-2 SDS, while in 109 patients it was <-3 SDS. 31 girls were at the 3 centile of height. The basic characteristics: the height of children (in cm and SDS) and those of mothers and fathers (in cm and SDS) as well as mid-parental height (in cm and SDS) are presented in table (Table 1).